-
Circulation 09/2009; 120(11):e86-8. · 14.74 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: We evaluated midterm results of endovascular management of traumatic aortic isthmic ruptures.
Between 2001 and 2008, 10 patients (seven males, mean age 38 years) underwent endovascular treatment of an acute aortic rupture. Eight procedures were emergent, with four cases of hemodynamic instability with Glasgow scores of 3, 5, and 7. Associated traumas were severe brain, liver, and pelvic bone injuries. All procedures were performed with transoesophageal echocardiography monitoring. We used two AneuRx and nine Medtronic Talent or Valiant stent grafts.
All patients survived their traumatic isthmic rupture. In nine patients, stent-graft deployment was successful. One patient experienced a distal migration needing a laparotomy and deployment of an additional new thoracic stent graft. The mean intensive care unit stay was 48 hr (range 24-168). The mean hospital stay was 11 days (range 8-43). All patients were controlled clinically and by contrast computed tomography (CT) according to the EUROSTAR protocol. There were no endoleaks, stent graft-related complications, or late deaths during a mean follow-up of 49 months. The control CT showed a lack of apposition of the proximal part of the stent graft at the inner curve of the aortic arch in three patients.
The midterm results of endovascular treatment of acute traumatic aortic isthmic rupture are encouraging and compare favorably to the surgical approach. Late follow-up is required to exclude possible stent-graft complications, especially in young patients with angulated aortic arches.
Annals of Vascular Surgery 06/2009; 23(5):634-8. · 1.03 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Our objective was to analyze retrospectively the short- and midterm results of the Ross operation in children and the impact of bicuspid aortic valve (BAV) disease on outcome. From 1991 to 2003, 41 patients (26 male, 15 female) underwent a Ross procedure. Aortic disease was congenital in all but one. Sixty-six percent had BAV. Mean age at operation was 10.13 +/- 5.6 years (range, 0.4-18.3 years). Root replacement technique was performed in all but two (inclusion technique). There were two early deaths. Mean follow-up was 6 +/- 3.8 years (range, 0.1-14 years). The autograft (neo-aorta) presented absent, trivial, mild, and moderate regurgitation in 42%, 46%, 10%, and 2%, respectively, at latest follow-up. Root dilation was seen in 64% of the patients (mean Z-score, +3.53 +/- 0.04). Four patients (9%) required allograft replacement, two for endocarditis and two for stenosis. Allograft stenosis (gradient >20 mmHg) was detected in 44% of the remaining patients, without symptoms or the need for reintervention. Estimated freedom from allograft replacement at 5 and 10 years was 97% and 89%. Left ventricular dimensions and function were normal in all patients. No difference was found between patients with BAV and those with tricuspid aortic valves in aortic regurgitation or root dilation. BAV was not identified as a risk factor for root dilation. In conclusion, the Ross operation remains an excellent option for aortic valve replacement in children. BAV is not associated with a worse outcome and is not a risk factor for aortic root dilation at medium-term follow-up. Long-term follow-up is, however, required.
Pediatric Cardiology 01/2009; 30(3):219-24. · 1.30 Impact Factor
-
The Annals of thoracic surgery 09/2007; 84(2):712. · 3.74 Impact Factor
-
P Astarci,
J M Guerit,
A Robert,
G Elkhoury,
P Noirhomme, J Rubay,
V Lacroix,
A Poncelet,
J C Funker,
D Glineur,
R Verhelst
[show abstract]
[hide abstract]
ABSTRACT: The aim of this study is to compare measurement of stump pressure (SP) and somatosensory evoked potentials (SSEP) made during carotid surgery as criteria upon which to base the decision whether or not to use a shunt. We included 288 patients who underwent for carotid surgery under general anaesthesia. We performed 247 endarterectomies with patch closure (85.7%), 25 carotid transsection with reimplantation (8.7%), and 16 carotid bypasses (5.6%). SSEP monitoring showed no modification in 225/288 patients (78.1%), moderate modification in 32/288 patients (11.1%), and severe modification in 31/288 patients (10.8%). Shunt was used if there was moderate or severe SSEP modification in response to carotid clamping, which represents 63 patients in our series. A shunt was used in 47/288 patients (16.3%). In 16 patients, despite SSEP modifications, the shunt was not used because these SSEP modifications occurred only in the last minutes of the procedure just before off clamping the carotid. The mean SP for all patients was 51 mm Hg. In the shunted patients, the mean SP was 33 mm Hg. Variation of SP was correlated with the SSEP modifications. There was just one perioperative stroke in this series (1/288 = 0.3%). We concluded that the threshold of SP below which shunting is indicated in our study was 44 mm Hg with 81% sensibility and 68% specificity.
Annals of Vascular Surgery 06/2007; 21(3):312-7. · 1.03 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Patients with aortic root pathology may benefit from 'valve-conservation' surgery although application of this philosophy is limited by a lack of 'standardized' surgical techniques. A functional classification of aortic root and valvular abnormalities has been developed in 260 patients and correlated with the etiology of the pathologic process and the surgical procedure performed. Early outcome was assessed using hospital records and medium-term follow-up by cardiological review.
From January 1995 until March 2001, 260 patients were operated on for aortic root pathology using valve-conserving surgical techniques. Hospital mortality was 2%; intra-operative echocardiography showed residual aortic regurgitation (Grade 1-2) in 11%, none in the remaining patients. Follow-up at a mean of 20 months (87% of patients) showed trivial or Grade 1 aortic regurgitation in 80%.
Application of a simple functional classification for aortic root pathology and aortic valve disease allows the logical application of 'valve-conserving' surgical procedures with excellent early and medium-term results.
Current Opinion in Cardiology 04/2005; 20(2):115-21. · 2.33 Impact Factor
-
Journal of the American College of Cardiology 07/2001; 37(7):2008-9. · 14.16 Impact Factor
-
Journal of Thoracic and Cardiovascular Surgery 06/2001; 121(5):996-8. · 3.41 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: In tetralogy of Fallot, transannular patching is suspected to be responsible for late right ventricular dilatation.
In our institution, 191 patients survived a tetralogy of Fallot repair between 1964 and 1984. Transannular patching was used in 99 patients (52%), patch closure of a right ventriculotomy in 35, and direct closure of a right ventriculotomy in 55. Two had a transatrial-transpulmonary approach. To identify predictive factors of adverse long-term outcome related to right ventricular dilatation, the following events were investigated: cardiac death, reoperation for symptomatic right ventricular dilatation, and NYHA class II or III by Cox regression analysis. Mean follow-up reached 22+/-5 years. The 30-year survival was 86+/-5%. Right ventricular patching, whether transannular or not, was the most significant independent predictor of late adverse event (improvement chi(2)=16.6, P:<0.001). In patients who had direct closure, the ratio between end-diastolic right and left ventricular dimensions on echocardiography was smaller (0.61+/-0.017 versus 0. 75+/-0.23, P:=0.007), with a smaller proportion presenting severe pulmonary insufficiency (9% versus 40%, P:=0.005). There was no difference between right ventricular and transannular patching concerning late outcome (log rank P: value=0.6), right ventricular size (0.70+/-0.28 versus 0.76+/-0.26, P:=0.4), or incidence of severe pulmonary insufficiency (30% versus 43%, P:=0.3).
In tetralogy of Fallot, transannular patching does not result in a worse late functional outcome than patching of an incision limited to the right ventricle. Both are responsible for a similar degree of long-term pulmonary insufficiency and right ventricular dilatation.
Circulation 11/2000; 102(19 Suppl 3):III116-22. · 14.74 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Coverage of large commissural defects may present a surgical challenge in mitral valve repair, for which the transfer of posterior tricuspid valve leaflet tissue is an attractive approach.
Five patients aged between 35 and 55 years underwent this procedure. After wide excision of the diseased mitral commissures, the posterior leaflet of the tricuspid valve was carefully checked, removed with its subvalvular apparatus, and transferred to the commissural area of the mitral valve. The stress on the papillary muscle suture was relieved by reinforcement of the free edge of the transferred leaflet by natural or artificial chordae. The tricuspid valve was repaired using either a sliding plasty or an annuloplasty.
One patient who had no reinforcement of the subvalvular apparatus had a papillary muscle rupture and required mitral valve replacement during the early postoperative period. The four remaining patients remained asymptomatic and had no or trivial mitral regurgitation after a median of 13 months (range: 3-18 months), with excellent result at transesophageal echocardiography.
We conclude that transfer of the tricuspid valve leaflet allows coverage of large commissural defect, and deserves a place among the surgeon's arsenal of reconstructive techniques for mitral valve repair.
The Journal of heart valve disease 06/2000; 9(3):350-2. · 0.81 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Repair of the prolapsing anterior leaflet (AML) in degenerative mitral valve disease is more demanding than that of the posterior leaflet. We reviewed our experience in the past eight years, to examine the safety, efficacy and stability of various repair artifices.
Between January 1989 and December 1997, 102 patients (mean age 64 years; range: 26-86 years) with mitral regurgitation (MR) due to prolapse of the anterior or both mitral leaflets underwent mitral valve repair. Sixty-six patients were in NYHA class > or =III, and 94 had MR grade >II. Acute endocarditis was present in 12 patients and Barlow disease in 16. Surgical techniques consisted of chordal shortening (n = 36), chordal transposition (n = 16), papillary muscle shortening or plication (n = 10), flip-over (n = 20) and artificial chordae implantation (n = 20).
There was no early mortality; one patient required early mitral valve replacement (MVR) for late-appearing systolic anterior motion, and one patient benefited from a successful re-repair on day 8 for partial posterior leaflet desinsertion. Mean follow up was 30 months (range: 3-92 months); there were four late deaths (two valve-related cerebrovascular accidents); two patients required re-repair (one after three months for prosthetic ring thrombosis, and one after 10 months for rupture of shortened chordae (corrected by flip-over)). Five patients had MVR between four and 32 months later: one for mitral stenosis due to posterior leaflet calcification, and four for recurrent MR due to the rupture of shortened chordae (n = 3) or plicated papillary muscle (n = 1). One patient suffered bacterial endocarditis which was treated medically. Of the 92 remaining patients with valve repair, 81 are currently asymptomatic, five are in NYHA class II and four in class III. Transesophageal echocardiographic restudy (n = 76) at a mean of 30 months after surgery revealed no MR in 68 patients, and MR of grade <II in three.
AML prolapse repair is safe, durable, and therefore can be attempted even in mildly symptomatic patients. However, chordal shortening should be substituted by implantation of artificial chordae or by the flip-over technique.
The Journal of heart valve disease 02/2000; 9(1):75-80; discussion 81. · 0.81 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Transannular patch repair of tetralogy of Fallot leads to pulmonary insufficiency and progressive right ventricular dilatation responsible for a decreased exercise capacity. We studied the impact of late homograft insertion on the regression of the right ventricular volumes in symptomatic patients.
Between July 1992 and August 1996, 15 consecutive patients (age range: 4 to 24 years) were operated on at a median of 13 years (range: 3 to 20 years) after transannular patch repair of tetralogy of Fallot. All patients complained of exertional dyspnea and fatigue. Syncopes were reported in six patients and four patients had sustained episodes of ventricular tachycardia. Fourteen had pulmonary regurgitation grade 3 or 4 and one had an associated stenosis and insufficiency. All patients had a dilated right ventricle. At reoperation, no patients presented with major aneurysm. The patch was resected and the right ventricular outflow tract reconstructed with a cryopreserved pulmonary homograft. Right ventricular volumes were studied before the procedures and at the last follow up consultation.
There was no operative death. One patient who had a concomitant patch repair of a hypoplastic left pulmonary artery needed extracorporeal circulatory support for eight days. After a median follow up of 25 months (range: 3 to 54 months) all patients but one are in NYHA class I. There were no late deaths. The mean end-diastolic diameter of the right ventricle decreased from 36 +/- 9 mm before surgery to 31 +/- 6 mm (not significant). The mean ratio between the end-diastolic diameter of the right and left ventricles decreased from 0.94 +/- 0.3 to 0.74 +/- 0.2 (p < 0.01).
An increasing number of patients who had transannular patch repair for tetralogy of Fallot will require reoperation for symptomatic long-term pulmonary regurgitation. Homograft reconstruction of the right ventricular outflow tract of these patients induces regression of their right ventricular dilatation and leads to their functional recovery.
The Journal of heart valve disease 08/1998; 7(4):450-4. · 0.81 Impact Factor
-
G Pompilio,
C Brockmann,
M Bruneau,
M Buche,
M Amrani,
Y Louagie,
P Eucher, J Rubay,
J Jamart,
R Dion,
J C Schoevaerdts
[show abstract]
[hide abstract]
ABSTRACT: The objective of this study was to analyse the impact of acute surgery for native aortic valve endocarditis and its influence on the long-term prognosis after surgery.
A total of 161 patients underwent aortic valve replacement for native active aortic valve endocarditis (NAAVE) during a 29-year period, from 1967 to 1995 (age range: 10 to 72 years; mean 48 +/- 12). The main indication for surgery was progressive congestive heart failure (76%). Other indications were untreatable sepsis (27%), peripheral or central emboli (12%) and, from 1978, echocardiographic evidence of friable, pedunculated vegetations (3%). Streptococcal and staphylococcal infections predominated. Concomitant procedures were performed in 27% of the patients, including mitral and tricuspid valve surgery and coronary bypass procedures.
Operative mortality was 8% in the majority of cases caused by heart failure or multi-organ failure. Multivariate logistic regression analysis identified NYHA class IV to be an independent predictor for postoperative death. Long-term survival for discharged patients was 75% at 10 years and 58% at 15 years, with a mortality rate of 3.6%/patient/year. Cox regression analysis identified the year of operation, trivalvular endocarditis and staphylococcal infection as independent predictors of survival. At 10 and 15 years after aortic valve replacement, 91% and 84% of the patients, respectively, were free of recurrent endocarditis. The presence of an abscess cavity at first operation was found to be predictive of recurrent endocarditis.
Valve replacement for NAAVE offers a good chance for a cure and satisfactory long-term survival. Improvements in pre- and per-operative management of the very ill patient, and the use of allograft valves are likely to further improve long-term results. Finally, the presence of staphylococcal endocarditis requires long-term postoperative antibiotic therapy.
Cardiovascular Surgery 05/1998; 6(2):126-32.
-
[show abstract]
[hide abstract]
ABSTRACT: Ventricular assist devices are widely used as a bridge for cardiac transplantation patients. The purpose of the present study was to evaluate retrospectively, whether the use of ventricular assist devices could increase survival after early or late retransplantation. Over the past 10 years, 219 patients were transplanted in the authors' centre. Eight of 11 retransplanted patients required preoperative insertion of a ventricular assist device. Five assist systems were implanted in the early period after transplantation ( < 30 days) and three later after transplantation ( > 30 days). After early retransplantation, two patients survived and three died. All three late retransplantations were successful and all patients are still alive with a mean (s.d.) follow-up of 25(22) months. Ventricular assist devices are helpful for late retransplantation but do not improve poor survival after early retransplantation. Such devices should not be set up for early retransplantation.
Cardiovascular Surgery 12/1997; 5(6):584-7.
-
[show abstract]
[hide abstract]
ABSTRACT: This study examines how the recording of the lumbar and subcortical components of the posterior tibial nerve (PTN) SEPs may usefully replace that of cortical components in situations in which these components cannot be reliably obtained (infants, high concentrations of halogenated gasses). Lumbar, brain-stem, and cortical PTN SEPs were intraoperatively monitored in 7 patients undergoing repair of aortic coarctation under variable isoflurane concentration (up to 1.2%). Four patients were less than 1 year old. Two distinct activities were evidenced at the lumbar level in all of the patients: the dorsal root component (DRC) and the dorsal horn negativity (DHN). The equivalent of the adult P30 (lemniscal positivity; LP) was also present in all of the patients, whatever their age or the concentration of isoflurane. By contrast, the parietal activities were absent intraoperatively in the youngest patients. Spinal-cord ischemia consecutive to aortic cross-clamping gave rise to early DHN changes and later alterations of the LP in the two patients in which it occurred, while the DRC and the peripheral nerve activities remained unchanged. This elective sensitivity of the DHN is likely due to it being dependent on the gray matter of the spinal cord, the basal metabolism of which is greater than that of the white matter and to the situation of the DHN generator in a watershed zone of the spinal cord. This study emphasizes the interest of PTN SEPs for spinal-cord monitoring in vascular surgery and the importance of combining the recording of parietal activities with that of the lumbar spinal components.
Electroencephalography and Clinical Neurophysiology 04/1997; 104(2):115-21.
-
[show abstract]
[hide abstract]
ABSTRACT: Between August 1986 and March 1993, 124 patients (102 men; mean age of 59 years) underwent myocardial revascularization with the use of at least one free internal mammary artery (FIMA). This group represents 4.5% of the 2725 coronary bypasses performed during the same period. Seventy-six patients (61%) had suffered from at least one previous myocardial infarction. Forty-five patients (36%) had unstable angina; three-vessel disease was found in 100 cases (80.5%) and a left ventricular ejection fraction lower than 0.4 in 22 (17.7%). There were 18 (14.5%) redo procedures and 90 (72.5%) bilateral internal mammary artery (IMA) grafts. The reasons for using a FIMA were: too short an internal mammary artery pedicle in 83 patients, IMA injury at harvesting in 30 patients and post-bypass ischaemia in areas grafted with pedicled IMA (PIMA) in 11 patients. Cardiopulmonary bypass, moderate hypothermia (30 degrees C) and crystalloid anterograde and retrograde cardioplegia were used in all cases. Sixty-seven FIMA grafts were anastomosed directly to the ascending aorta; 57 were sutured via a saphenous hood using a running suture of polypropylene 7/0 and three were anastomosed end-to-end to a PIMA graft. FIMA grafts were directed to the left anterior descending (34%), the circumflex (37%) and the right coronary artery (29%). In total, 179 anastomoses were constructed using 127 FIMA, 136 using PIMA and 158 using saphenous veins (3.8 anastomoses per patient). Hospital mortality and postoperative myocardial infarction rates were 5.6% (seven patients) and 3.2% (four patients), respectively. Cardiac-related mortality was 3.2% (four patients); three of these four patients had been operated on for evolving infarction and one underwent a redo procedure. Four of the 117 survivors died later on; in two, it was cardiac-related and a result of global heart failure at 9 and 12 months. Of the 113 remaining patients, 106 are symptom free after a mean follow-up of 28.2 (range 3-84) months. Fifty-nine patients (50.4%) were restudied by angiography at a mean interval of 15 months. Patency rates of FIMA anastomosed either directly to the aorta or via a saphenous hood were 82.8 or 89.7%, respectively. Patency rates of FIMA directed to the left anterior descending, the circumflex and the right coronary artery were 85.7, 88 and 83.3%, respectively. Global FIMA patency was 86.4%, while global PIMA patency was 100%. The FIMA mid-term patency rates compare unfavourably with those of PIMA: FIMA should therefore be restricted to the cases where PIMA or other pedicled arterial grafts are unavailable.
Cardiovascular Surgery 05/1996; 4(2):212-6.
-
[show abstract]
[hide abstract]
ABSTRACT: The usefulness of somatosensory evoked potential (SEP) monitoring as a means of preventing paraplegia in descending aorta surgery was evaluated in 47 consecutive cases operated on for isthmic (14 cases), thoracic (22 cases), or thoraco-abdominal (11 cases) repair. An aortic dissection was found in 11 cases (acute in 6). Somatosensory evoked potentials were obtained by unilateral left and right posterior tibial nerve (PTN) stimulation at the ankle and recordings were performed on four channels: peripheral nerve, lumbar spinal, brain-stem, and cortical recordings. Our experience led to the following current strategy: the establishment of atrio(aorto)-femoral(aortic) bypass (29 cases), proximal and distal aortic cross-clamping, aortic repair with reimplantation of the culprit artery(ies) as indicated by SEP alterations. Five types of SEP alterations were defined on the basis of the neural level involved: type I (27.7% of cases) = distal spinal ischemia due to proximal aortic cross-clamping in the absence of bypass; type II (21.3%) = PTN ischemia due to left common femoral artery cross-clamping; type III (12.8%) = segmental spinal ischemia due to the exclusion of critical feeding arteries; type IV (4.3%) = ischemia in the left carotid artery territory; type V (4.3%) = global brain hypoperfusion due to systemic hypotension. Forty-five patients survived the operation and could be tested for neurological dysfunction. Three patients presented a postoperative spinal cord deficit, but this deficit was already present preoperatively in one case, so that the actual incidence of a new paraplegia in our series was 2/45 cases (4.4%). One of the two cases was clearly a delayed paraplegia with SEP alterations appearing several hours after the operation. Somatosensory evoked potentials were evaluated on the basis of their sensitivity, specificity, and impact on the surgical strategy. Regarding SEP sensitivity, we did not encounter any unexpected immediate paraplegia, but the critical factor appeared to be the duration of SEP absence due to spinal cord ischemia, which, according to the literature, should never exceed 30 min; after a longer absence, SEP return does not guarantee neurological recovery. Somatosensory evoked potential specificity was also 100%, but only 58% of the abnormalities found were actually consequent to spinal cord ischemia, the rest of the abnormalities being consequent to peripheral nerve or brain ischemia. Finally, SEP monitoring had a significant impact on surgical strategy in 19% of the cases. It is concluded that distal aortic perfusion and multilevel SEP monitoring play a significant role in preventing paraplegia in descending aorta surgery.
European Journal of Cardio-Thoracic Surgery 02/1996; 10(2):93-103; discussion 103-4. · 2.55 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: During the period 1970-1993, 116 patients (63 men, 53 women) with native aortic valvular infective endocarditis were treated surgically. The mean age was 37 years. The main causative organisms were streptococci and staphylococci. Indication for surgery was cardiac failure (70 cases), uncontrolled sepsis (30), peripheral emboli (11) and overwhelming destruction of the aortic valve (five). Hospital and late mortality rates were 8% and 11% respectively. Patients who died in hospital and those who presented a paravalvular leakage had a ring abscess associated with aortic wall destruction. Among 34 patients screened for cerebral septic emboli the condition was confirmed in 15, of whom six were symptom-free. Thus, it is believed that in the presence of root abscess, surgery should be undertaken promptly, regardless of the cardiac status. It is confirmed that cerebral septic emboli should be systematically screened for in the presence of any infective endocarditis.
Cardiovascular Surgery 01/1996; 3(6):579-81.
-
[show abstract]
[hide abstract]
ABSTRACT: Although rare, sports related sudden cardiac deaths in children and adolescents justify the search for risk factors in any child or adolescent who wishes to practice sports. Each time that history and careful clinical cardiovascular examination point to a possible cardiovascular abnormality, an electrocardiogram and an echocardiography must be performed. Exercise testing is useful to appreciate the cardiovascular tolerance, either in normal subjects or in subjects with a cardiovascular abnormality; its interpretation requires good knowledge and understanding of hemodynamic responses to exercise. Indications, risks and procedures of exercise testing are discussed with reference to exercise physiology.
Archives de Pédiatrie 12/1995; 2(11):1101-15. · 0.30 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Balloon dilatation, an established treatment for pulmonary valve stenosis, remains a controversial procedure in tetralogy of Fallot.
Balloon dilatation of the pulmonary valve was performed in 19 infants with tetralogy of Fallot. Its effects on the severity of cyanosis, the growth of the pulmonary valve and pulmonary arteries, and the need for transannular patching were evaluated. Clinical, echographic, angiographic, hemodynamic, and operative data were analyzed. The procedure was safe in all, without significant complications. After balloon dilatation, systemic oxygen saturation increased from a mean value of 79% to 90%. This increase proved to be short-lasting in 4 patients, who required surgery before the age of 6 months. Balloon dilatation increased pulmonary annulus size in each case, from a mean value of 4.9 to 6.9 mm (P < .001). This gain in size remained stable over time, with a mean Z score of -4.8 SD before dilatation, -3.1 SD immediately after the procedure, and -2.7 SD at preoperative catheterization (P < .001). Pulmonary artery dimensions remained unchanged immediately after balloon dilatation but increased at follow-up from a Z score mean value of -2.5 to -0.06 SD and from -2.2 to 0.04 SD for right and left pulmonary arteries, respectively (P < .001). At the time of corrective surgery, the pulmonary annulus was considered large enough to avoid a transannular patch in 69% of the infants. This represented a 30% to 40% reduction in the need for a transannular patch compared with the incidence of transannular patch expected before balloon dilatation.
Pulmonary valve dilatation in infants with tetralogy of Fallot is a relatively safe procedure and appears to produce adequate palliation in most patients. It allowed the growth of the pulmonary annulus and of the pulmonary arteries, resulting in a mean gain of 2 SD for those structures.
Circulation 03/1995; 91(5):1506-11. · 14.74 Impact Factor
